I've sat by long enough and finally decided today I'd chime in with my recent experience. Apologies for deliberate vagueness and abstract format, but I enjoy my anonymity (it therefore affords me the luxury of being honest).
Background: AMG (MD only) from lower-tier medical school; AP/CP at mid-tier midwest program (that, in retrospect, is/was malignant and I would never recommend); Fellowship #1 in surg-path subspecialty at well-known/competitive program with well-known mentor; Fellowship #2 in competitive surg-path subspecialty with well-known mentor.
Goals: I opted for two fellowships because I wanted to -- I have been working towards an academic position since before medical school. Not looking to do the PhD labStuff, but wanted to corroborate with a few PhD friends and do the clinical end of it. Plus I actually enjoy pushing glass. So goal was an academic position where I could teach and support my PhD friends from the clinical end. Not looking to "overtrain pathologists" or add to the existing problem (I agree, there are probably too many path training programs).
Job search: Cold-emailed a few places starting in early July. Got absolutely no positive responses -- I don't recommend this strategy. One guy was frankly an dingus about it (I wished him luck in recruiting pathologists after I found out he needed several in his department last week. He's gonna need it.).
From job ads I came across, I ended up filing 10 applications in July - 5 academic, 5 private - all in desirable large cities (I'm a metropolitan guy) and didn't settle for anywhere I knew I wouldn't want to live. Talked to my mentors and anyone I could about the positions before applying - specifically avoided 3-4 well-known places who were looking for my niche specialty combo for that reason. My former residency institution was looking specifically for that combo as well...I didn't even apply (like I said...malignant).
Results: By 1st week of August, I had three interviews scheduled for the 1st week of September. Interviewed at all three in September and had offers from all three by 2nd week of September. Contract negotiated and signed by end of 2nd week of September - major academic institution which needed my specific combos and is in a great city. Plenty of research time/academic time and starting salary >$250K.
Only one outright rejection from a private practice (which I expected given that they wanted someone with 5-10 yrs experience and only wanted that person to do one of my areas alone...but I applied because I thought wth and it's in a city I'd like to see). Everyone else I didn't hear from and ended up emailing them asking not to consider me further.
Conclusions/Things I learned: Probably didn't need the second fellowship. The job that fit well for me came along sooner than later, so maybe I was lucky. But I look periodically at the job boards now and I see a number of jobs that I likely would have applied to if I were still searching now. I think being "normal" and amiable was probably the best strength I had. My mentors helped a lot - not necessarily in "making calls", but rather they were available by phone and were good references when I needed them to be. I know I'm cynical about this whole job search concept in our field (again, I've seen complete idiots get jobs paying more than I will ever make in academic pathology), but I still think that for well-qualified candidates who are amiable, realistic, flexible and not incompetent jerks - the job market is fine.
Not positing this to be an obnoxious "look at what I can do" jerk...just posting to say that I think for the right candidates who are willing to be flexible, the market has arguably improved/is fine. I think another poster's point about "don't go into pathology if you can't be flexible" is absolutely on point. Much like sex (and possibly the rest of life), flexibility is the key to success.